Neuro ICU - Do you talk to brain-dead patients?

dgudmestad · Aug 1, 2005

I bathe dead people......why shouldn't I talk to them, even if only to hear the hum of my own voice. Doesn't really matter either way.

This past january, my family was told that my father would never "wake up" after having a quadruple bypass. The neurologist said it was a lost cause and the icu nurses told my mother that we should consider pulling the plug and i did not once see them talking to him, until....... we kept talking to him for hours and hours every day and low and behold he AWOKE. My my, that was a quick trip from brain dead to alive and well huh!!! To make a long story short, Doctors do not know everything, and we as nurses should make a point of ALWAYS talk to the patient, no matter what the condition. And yes, my father remembers hearing voices and could recognize our voices but could not really understand what we were saying.

psalm, RN · Aug 1, 2005

...I talk to the pt. and I talk during postmortem care. I do this with family present and/or with nurse aide or new nurse AND when I am alone as respect to this person who has departed this life. Also, when I was a new nurse it helped ME thru the death of my pt., to focus on her needs. My job doesn't stop with the last beat of the heart.

ptadvocate81 · Aug 1, 2005

I'm about to begin a Masters research project about ICU nurses talking to brain-dead patients (oh the joys of ethics approval committees!). My interest in this started when I read 'Rethinking life and death' by ethicist Peter Singer - he described observing nurses in ICU talking to brain dead patients as though they were alive, and from that decided they did it because they didn't understand that the patients were clinically dead.
I think that nurses who talk to their brain dead patients do it for a variety of reasons, which may included (but are not limited) to issues about reconciling the apparently living body (sensory knowledge) with knowledge about brain death (intellectual knowledge). I don't work in ICU, though I do work on a nero unit; I always talk to the unconscious, and sometimes talk to patients who have died.
I was at a conference in the UK last year, and an ICU nurse educator said that she not only never talks to brain dead patients, she corrects any students who do. However, one of the anaesthetists there always speaks to his brian dead patients. They're ruining my research!
What do you all think? This isn't something that will make it into my thesis, BTW, but I'm interested in what you think about the project idea, and about your own practice.

I work in SICU, and unfortunately I see quite a few brain dead patients, and yes, I always talk to them as I would a regular patient. Why? I have found that it is comforting to the families to hear you talk to them as though they are still with us, and I figure the only way to remember to do that during the brief visiting hours is to do it all the time. Besides, no one really knows where their soul is during this time...

**RosesrReder, BSN, MSN, RN** · Aug 1, 2005

I always talk to unresponsive pts..because even with the technology we have today, the mind/brain still has much that is NOT understood..so I always explain what I am going to do with/to them..treat them as if they CAN hear/understand me..how many times have you heard of a pt who was in a coma/brain dead that has eventually 'come back' and recalled many things..not often..but on rare occasions..I'd like that pt to remember staff/family talking to them and treating them respectfully..that's just me :)

You are definetly right, there is so much we don't know, so it serves to "just in case". :)

jmgrn65, RN · Aug 1, 2005

I have done so when in that situation (which hasn't been all that often), just as a gesture of respect to the person (and family, if present), and because I just don't KNOW what may or may not be going on inside the person. The research I have read indicates that hearing is the last sense to "go" when one is dying, and, although I haven't read anything about how that applies in the case of brain death, it seems like a useful thing to keep in mind.
To me, it seems like a question of practicing the principle of nonmaleficence -- if I talk to the person and s/he can't hear me, no harm is done -- but if I go in the room and treat the person like a slab of meat and s/he does still have some primitive, basic level of awareness, then I have done harm ... I try to treat patients with the same care and respect that I would want someone to show me.
It isn't that I don't understand the principle of "clinically dead" -- it's that I do understand that we don't always have all the answers, and don't always know as much as we like to think we do ... :)[/quote
I like how you stated it, that is my feeling also, you have put it words better than i could have.

grannynurse FNP student · Aug 1, 2005

I have always spoken to unresponsive patients. It has been a matter of respect, for them, and their family. And I had the experience of having a patient regain consciousness and relating all of the inappropriate conversations that had taken place at her bedside, including some members of the medical staff referring to her as a gork. I made sure she repeated her conversation to the house staff.

Grannynurse :balloons:

mandrews · Aug 1, 2005

Yes I do. I had a patient with a brain tumor and I would read her cards to her from her Church family and sometimes she would kind of wiggle her body around. I know she could hear me.

I was assessing a patient last week and a family member said nurse she can't hear you. I cheerfully said the hearing is usually the last thing to go. :)

I received a very funny look, but I kept on talking.

melissa

kea6783 · Aug 4, 2005

I would and applaud those who do. I hope if I was ever the pt my nurse would talk to me. I don't care who tells me just how dead my brain would be in that case, even if you put it in bold! :uhoh3:

utahliz · Aug 6, 2005

Sarah Scantlin, recently emerged from a 20-year coma, was able to recall events that happened while she was comatose, such as 9/11.

papawjohn · Aug 6, 2005

Hey Y'all

New here. Old nurse, though. Lots of NeuroTrauma background.

Think it's sorta surprising that there's so much (17pages!!) of chat regarding coma, vegetative state, etc when the subject was brain-death. (Interesting chat--no offense intended).

A few years ago when I was young and knew alot, the DX "brain death" was (note--medical diagnosis!!!) done like this:

Ice Water Calorimetrics--large syringe of ICED water drawn up by Neurologist/N-surgeon. Forcefully (FORCEFULLY!!!) injected into Pt's ear. Functioning brain-stem will cause the Pt's eyes to jerk toward the side getting the iced h2o bath. No deviation of eyes = no function of brain stem = brain death.

Apnea test--Pt is hyperventilated for 15-30min to blow off CO2. ABGs are drawn. Pt is taken off VENT. Pt is put on Nasal Cannula at high flow. (Everyone understands--these Pts are ALWAYS on vents, yes?) Serial ABGs are drawn (usually an A-Line is put in for this test if not already in). Lack of respirations is shown by progressively increasing pCO2 levels. (The pO2 level stays high because the Oxygen is passively swirling in the airways.) Lack of respirations = lack of brain stem = brain death.

EEGs can confirm the DX but are not necessary in the two states where I practiced in these units (TN & MD).

Transplantation vultures descend AFTER all the above.

Like others, I have had distastful experiences with vultures. (I'm sure there are lots of wonderful transplantation-nurses. No personal attack intended.)

The original question: "Do you talk to your brain dead Pt?"

Answer: Of course!!! I care for a person. I always talk to persons.

Never had a NDE myself but was put to sleep once in a hospital where I worked and the folks all knew me. They assumed I was 'under' and had a few laughs at my expense. Nothing they'd be ashamed of if they'd known I was eavesdropping--but not intended for my ears!

Papaw John

utahliz · Aug 6, 2005

Think it's sorta surprising that there's so much (17pages!!) of chat regarding coma, vegetative state, etc when the subject was brain-death. (Interesting chat--no offense intended).
Papaw John

Good point, I guess I was lumping them together.

GenaRN · Aug 8, 2005

But I don't recall talking to brain dead patients. It seems odd, I wouldn't talk to a dead body, it seems disrespectful to say "Mr So-So, we are going to turn you now" to a dead body, just a it would be to not say the same thing to a comatose patient. It's an interesting topic of discussion for sure.

I'm about to begin a Masters research project about ICU nurses talking to brain-dead patients (oh the joys of ethics approval committees!). My interest in this started when I read 'Rethinking life and death' by ethicist Peter Singer - he described observing nurses in ICU talking to brain dead patients as though they were alive, and from that decided they did it because they didn't understand that the patients were clinically dead.
I think that nurses who talk to their brain dead patients do it for a variety of reasons, which may included (but are not limited) to issues about reconciling the apparently living body (sensory knowledge) with knowledge about brain death (intellectual knowledge). I don't work in ICU, though I do work on a nero unit; I always talk to the unconscious, and sometimes talk to patients who have died.
I was at a conference in the UK last year, and an ICU nurse educator said that she not only never talks to brain dead patients, she corrects any students who do. However, one of the anaesthetists there always speaks to his brian dead patients. They're ruining my research!
What do you all think? This isn't something that will make it into my thesis, BTW, but I'm interested in what you think about the project idea, and about your own practice.